When the first case of coronavirus disease 2019 was diagnosed in Washington on January 20, 2020 clinicians at Seattle Cancer Care Alliance decided to act expeditiously and unhesitatingly to minimize disease spread.
Masumi Ueda, MD, MA
When the first case of coronavirus disease 2019 (COVID-19) was diagnosed in Washington on January 20, 2020 clinicians at Seattle Cancer Care Alliance (SCCA) decided to act expeditiously and unhesitatingly to minimize disease spread. Unbeknownst at the time, Seattle would quickly become one of the first epicenters of COVID-19.
Masumi Ueda, MD, MA, assistant medical director for inpatient blood and marrow transplantation at SCCA in Seattle, Washington, said her early awareness of COVID-19’s rapid community spread crystallized the reality that the novel respiratory virus would have a significant and wide-ranging impact not only in Washington state but also on SCCA.
“When the first death occurred in Washington state, it was so close to our center. Models of how the virus had spread in our communities and the expected surge in cases were a huge turning point for us,” Ueda said in an interview with OncLive®. “We had the advantage of having local experts who were on top of things and planning ahead, and that allowed us to very quickly respond to our community situation.”
Washington state reported its first COVID-19-related death on February 29, 2020.1 By March 14, Washington state had 642 cases of COVID-19 and 40 deaths.2 At SCCA, the race to build a COVID-19 conscious care infrastructure was on.
“There were a lot of decisions that needed to be made quickly, and [it was] an initial jarring moment where we had to establish the incident command and orient ourselves,” Ueda said.
Policies to Limit COVID-19 Community Spread
The pandemic-specific alterations to SCCA’s standard workflow, detailed by Ueda et al in a special feature in the Journal of the National Comprehensive Cancer Network, “Managing Cancer Care During the COVID-19 Pandemic: Agility and Collaboration Toward a Common Goal,” outlines preventative measure, such as patient screening at the doors of the cancer center.
SCCA’s emphasis on equal preliminary screening for patients, visitors, and clinicians alike has been key to the center’s efforts to mitigate disease spread, because the nondiscriminatory nature of COVID-19 means that any 1 of these groups could unwittingly carry and transmit the virus. Patients, visitors, and staff are required to complete COVID-19 screening before entering the hospital and outpatient clinics. Those who do not display signs of infection are permitted to proceed through SCCA, whereas symptomatic individuals are directed to a separate screening area where they can submit nasopharyngeal swabs for testing, thanks to Seattle’s “early access to COVID-19 testing.”2
Protocols such as SCCA’s at-door screening have allowed the center to control and prevent onsite patient and staff exposure to the respiratory illness. Although some SCCA staff members have been diagnosed with COVID-19, Ueda said “most if not all cases have been contracted in the community and not acquired in the clinic or in the hospital.”
Throughout SCCA’s experience with COVID-19, the center has consistently issued the same “strong message” to its clinicians: “if you have symptoms you should not be at work,” Ueda said.
SCCA, Ueda added, has continuously conveyed to its clinicians that its network of care providers is both capable and broad enough to offset absences due to suspected cases of COVID-19. “Having the reassurance that there is adequate backup coverage for physicians and other clinical staff is important, so they don’t feel badly about missing work if they have symptoms,” Ueda said.
This communication with SCCA clinicians, coupled with the use of telemedicine to facilitate nonurgent appointments, the postponement of elective surgeries, and the development of educational resources such as patient handouts, signs, and a phone triage line for patients with mild symptoms has helped keep patients and visitors safe, Ueda said.
Preparations for a Spike in COVID-19 Cases
These early modifications to SCCA procedure have helped SCCA restore equilibrium following the virus’ appearance and circulation in Washington. “[COVID-19] has dramatically changed how we operate, and we went through several stages [of preparation], but after the initial setup of infection prevention control measures, we began to assess our daily priorities in a more controlled fashion,” Ueda said.
Ueda added that SCCA “has done very well” in quickly adapting to the challenges posed by COVID-19 and remains “in a good place right now” to continue confronting community spread. Moreover, efforts to “brace” SCCA for COVID-19’s apex in Washington have been “very well coordinated.”
Data from The Institute for Health Metrics and Evaluation (IHME), an independent population health research center at the University of Washington (UW), indicated that COVID-19 would cause Washington to reach peak hospital resource use on April 2. Currently, the model projects that the death toll will be the highest during the first 2 weeks of April, with an estimated 19 deaths per day on April 6; 18 from April 7-9; and 17 deaths from April 10-13. Thereafter, COVID-19—related deaths in Washington should begin to decline, according to IHME.3
Along with rampant community spread, Ueda said SCCA also expects to see increased COVID-19 presence in its inpatient side during this period. To prepare for this anticipated spike in cases, SCCA began surge capacity planning and has also been closely monitoring its supply of personal protective equipment (PPE), including masks, gloves, and goggles. SCCA updates its inventory of PPE and the amount of time that the stock will sustain its day-to-day needs on a daily basis, Ueda said. The cancer center has also preemptively searched for other sources of PPE, such as donations, to prevent any shortages.
Although several hospitals and other institutions across the United States have struggled with dwindling supplies of PPE, SCCA “hasn’t faced the dramatic shortages that other regions of the country with denser populations have faced,” Ueda said. “Right now, our frontline healthcare workers have what they need to safely and adequately care for patients, and I think we’re lucky in that respect.”
This may be due in part to SCCA’s dedicated focus to oncology care. “Compared to other specialties, we already use a lot of PPE in caring for patient with cancer, so I think we started off with a better stock than, say, a community center [which] doesn’t routinely care for cancer patients,” Ueda explained.
Communication Is Key
Beyond keeping a watchful eye on essential equipment such as PPE, collaboration between SCCA and its neighboring Seattle oncology institutions, Fred Hutchinson Cancer Research Center and UW Medicine, has also enabled SCCA to proactively tackle COVID-19 and its clinical complications.
Continuity is a cornerstone of SCCA, Fred Hutchinson Cancer Research Center, and UW Medicine’s approach to the COVID-19 pandemic. In working together, the partner organizations have standardized disease-specific protocols such as preliminary screening across the 3 sites and established cohesive incident command structures. “Policies have to be coordinated tightly with all 3 systems,” said Ueda. The institutions meet regularly to shape these pathways as COVID-19 evolves and new information becomes available.
Cooperation among the sites not only facilitates the exchange of actionable clinical insights but also accessibility to critical resources, including COVID-19 testing. “Our center benefited from having testing available early because of the virology lab at University of Washington,” Ueda said. With the virology laboratory at its disposal, SCCA was able to test “hundreds of thousands of patients who were symptomatic early in the course of the disease,” according to Ueda, who added that, broadly, many “other cancer centers did not have this ability.”
Further, the uniformity in COVID-19—conscious care and the disease-specific protocols that SCCA, Fred Hutchinson Cancer Research Center and UM Medicine have collaboratively instituted and standardized provide physicians with a formulaic pathway that they can follow to safely optimize care at a critical time in medicine.
“The most important thing is collaboration. Working as a group and having a shared vision is imperative to providing the care that is urgently needed to our patients,” said Ueda.